Clinical Evaluation

for Juveniles’ Competence

A Guide for Judges and Lawyers

Thomas Grisso and Gina Vincent

University of Massachusetts Medical School

Bringing Research to Policy and Practice

Improving Practice for Evaluations

of Juveniles’ Adjudicative

Competence

• National Juvenile Court Clinician Survey

of Practice (2001-02)

• Guidelines for Juvenile Competence to

Stand Trial Evaluations (2002-04)

• Teaching the Guidelines: Nationwide

Regional Workshops for Juvenile Court

Clinicians (2005)

The National Juvenile Court

Clinician Survey

Lead clinicians in 87 of the largest juvenile courts

Interviewed to learn about:

How services were provided, by whom

Current juvenile CST evaluation practices

What needs they had for doing these evaluations

Types of Service Arrangements

• Court Clinics

• Community Mental Health Clinics

• Private Practitioners

Percent of Cities Using Models

By Region of U.S.

0

10

20

30

40

50

60

70

80

Pac-Wst Farm NE-GrL South

Ct Clnc

CMHC

PrivPrac

Frequency of raising the question

Frequency of referrals for JCST evaluations

in 2003, in 87 of 100 largest juvenile courts

Percent

5

40

25

18

12

0

5

10

15

20

25

30

35

40

0 1 to 10 11 to 25 26 to 99 100+Frequency

Survey of clinical services, 2003, 87 of 100

largest juvenile jurisdictions in U.S.

J-CST referral trend compared to previous year

(percent of JCC services)

50

38

12

0

5

10

15

20

25

30

35

40

45

50

increasing stable decreasing

The JCC Survey:

Hours Spent on Average J-CST Evaluation

(percent of courts surveyed)

20

5

41

16

32

54

6

21

04

0

10

20

30

40

50

60

1 to 2 2.1 to 4 4.1 to 9 9.1 to 17 17.1 to 32

Collect Data

(med = 3.5)

Total Time

(med = 6.3)

Developing a Guide for Juvenile

Competency Evaluations

Developing consensus on recommended practices

and

Producing tools to promote them

Teaching them to juvenile court clinicians nationwide

Consensus Process

• Expert juvenile court clinician panel– Developed the prototype concepts and methods

• National panels of clinicians and legal professionals (judges, prosecutors, defenders)– Developed consensus on practical application of the concepts and methods

• Piloting, feedback to the panels, refinement

The Guides

Contents of the Guide

• Legal, Forensic, and Developmental

Concepts for J-CST Evaluations

• Preparation for the Evaluation

� Referral—Determining, scope and methods

� The Defense Attorney—Making contact

� The Caretakers—Making contact and invitations

� Records, interviews and testing

The Guide (cont’d)

• The Data Collection Process

� Preparing the youth and caretakers

� Obtaining a developmental and clinical

history

� Evaluating developmental and clinical

status

� Assessing competency abilities

� Exploring caretakers’ perceptions of

youth’s adjudication

The Guide (cont’d)

• Interpretation of Data� Formulating opinions related to competency

� Formulating remediation

� Writing the report

• Appendices (reproduced in the guide’s CD)� The Clinicians’ Records Form

� The Interview Guides

� The “Juvenile Adjudicative Competence Interview” (JACI)

� The “Attorney CST Questionnaire”

Recommended Content

of Juvenile

Competence Evaluations

What Juvenile Competence

Evaluations Ought to Provide

Courts When Describing Youths

• The youth’s psychological status

–Clinical and developmental characteristics

• What the youth can and cannot do

–Legal competency abilities and deficits

• Why the youth has deficits in abilities

–Causes of deficits in legal competency abilities

• What can be done

–Potentials to remediate incompetence

The Youth’s Psychological

Characteristics

• Clinical conditions

– Mental illness

– Mental retardation

• Developmental conditions

– Degree of maturity of cognitive abilities

– Degree of maturity of social-emotional

capacities relevant for CST

What The Youth Can

and Cannot Do

• Legally relevant abilities for trial participation

• The legal standard for CST

A defendant must have:

…sufficient present ability to consult with his

attorney with a reasonable degree of rational

understanding…

…and a rational as well as factual understanding

of the proceedings against him

(Dusky v. U.S, 1960)

• The relevance of decision making capacities

Capacity for factual and rational

understanding of…

• Nature of the Trial Process

• Accused of a crime

• Court will decide guilt

• Could be punished

• What possible sentences are

• Meaning of possible pleas

• Roles and functions of trial participants

• What trial process involves (“trial process” is pretrial preparation and events through trial)

Ability to assist counsel….

• Capable of comprehending counsel’s inquiries

• Capable of responding to counsel inquiry and providing relevant information

• Can handle the demands of trial process (won’t decompensate under stress, demeanor won’t jeopardize fairness, can testify relevantly)

Decisional ability…

• Able to make decisions based on

rational beliefs and perceptions

• Able to process/weigh information

Why Youth Has Deficits in Legally-

relevant Abilities (if deficits exist)

• Is there a connection between their

clinical/developmental status and their

deficits in legal competency abilities

• Or are they due to other factors…e.g.

– lack of exposure to what they need to know

– malingering

Potential for Remediation

• Can the deficits be remediated?

• If so, in the time allowed?

• With what methods?

Guidelines for Performing

Juvenile Competence

Evaluations

10 ways in which doing competence

evaluations with juveniles require different

methods than with adults

#1 - Developmental child expertise

of the examiner

• Examiners of J-CST evaluations

should be specialized in:

– The diagnosis of children’s mental

disorders

– The assessment of youths’

developmental capacities

#2 - Developmental concepts

to guide the logic

• Defining “immaturity”– Immaturity is a relative term

“Immature compared to whom?”Adults? Average adolescent? Own age peers?

– Age is not synonymous with developmental level

Do not presume level of maturity based on age

– Maturation is not all-or-none

Always identify the specific developmental ability or characteristics in question

#2 - Developmental concepts

to guide the logic (cont’d)

• Biological Development

• Intellectual Development

• Psychosocial Development

– Autonomy

– Risk Perception

– Time Perspective

– Abstract Thinking

#3 - Both clinical and

developmental information

• CST evaluations require defining reasons for deficits in CST abilities

• Traditionally those have been clinical disorders, requiring information about symptoms

• With youths, potential deficits due to immaturity require additional inquiry into cognitive and social development

#4 - Special importance of

historical records of development

• Examiners should obtain and

review, whenever possible, past

records from:

– School

– Pediatrician/physician

– Child Mental Health services provider

#5 - Involvement of defense attorney

• Involvement of defense attorneys

are important for

– Testing specific hypotheses

– Improving ability to address specific

reasons for referral

– Understanding the attorney’s

observations that led to the referral

– Protection of the youth’s rights

#6 - Involvement of caretakers

• Caretaker involvement recommended

� To obtain youth’s developmental history

� Assess caretakers’ abilities to assist youth in

understanding and decision making

• Controversy about caretakers

� About presuming parents can compensate

(legally they cannot waive youth’s constitutional

rights)

� About parents’ conflicts of interest

� About parents’ emotional capacities

#7 - Multiple interviews

• Recommend more than one interview

with youths (a few days apart)

– Youths’ appearance day to day is less stable

than adults—”one look” on one day is more

likely to be misleading

– If youths are assisted to understand trials on

first interview, second interview allows one to

see if they retained it

#8 – Assessing Capacity to Learn

• Some youths do not understand trial

information simply because they have not

been exposed to it (rather than being

incapable)

• Clinicians should “teach” them some of the

things they do not know to see if

– They have the capacity to learn, or

– They have developmental problems that

interfere with learning

#9 – Assessing Appreciation

• With youths, factual understanding is less often the problem than is the ability to use information in making judgments about decisions

• Does the youth grasp the significance of what he/she understands for own situation?

• Example: – Accurate factual understanding: “Attorney helps

the defendant”

– Inaccurate appreciation: “My attorney can’t help me because I did the offense” or

“My attorney will have to tell the judge if I did the offense.” (Defense is only for the innocent.)

#10 – Assessing Judgment

in Decision-making

• Many youths may understand “what”

a plea agreement is, but have

developmental difficulties when

making plea “decisions”

• Examples:

– Immature time perspective: Focusing only on

short-term rather than long-term consequences

– Immature peer influences: Focusing only on

what peers would say rather than deciding what

might be best for oneself

The Juvenile Adjudicative

Competence Interview (JACI)

• An interview guide for clinicians

• Provides standardized questions covering trial process, participants, roles, decisions of defendants

• For each question, examines both factual understanding and appreciation

For example….

Example: Juvenile Adjudicative

Competence Interview (JACI)

• Understanding:

Before a juvenile court trial, defendants are asked whether they plead “guilty”or “not guilty” to the offense. What does “pleading guilty” mean?

• Appreciation

What will happen at court if you plead “guilty”?

What will happen if you plead “not guilty”?

In Closing

• Juvenile CST evaluations are relatively new

• These evaluations must be performed differently than with adults

• The ‘guides’ produced by the MacArthur foundation may be seen as a set of emerging principles for J-CST evaluations

• It is important for clinicians to provide judges and lawyers information about youths CST abilities that are developmentally sensitive